| NPI | 1740511187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TN 2805) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 58.003439) |
| Enumeration Date | 2010-01-25 |
| Last Update Date | 2019-11-08 |